APPLICATION FOR DAY PROGRAM SERVICES
This is NOT an employment application.
If you would like to join #TeamPalmer, please click here.
Additional Information that MUST be submitted by email or faxed to (573) 777 - 4802 (Attention: Day Program Admissions) to be considered:
o Copy of Current Individual Support Plan and any addendums with all needed signatures
o Copy of Current Immunization Records (Must contain Hepatitis B and Tetanus information)
o Copy of current Medication Administration Record if not listed on application
o Copy of physician’s orders regarding diet if applicable (lunch/snacks will be brought from home)
o Copy of Seizure Protocol (If applicable)
o Copy of any Functional Behavior Assessment completed in last two years (if applicable)
o Copy of Behavior Support Plan (If applicable)
Note: Before first day of attendance, copies of ALL physician orders for any medication that will be administered during day program hours, including all PRNs, must be provided.
New MAR must be provided on the first day attendance of each month as well as any updated physician orders before individual can attend.
All PRNs and any scheduled medications to be administered during day program hours will need to be provided at the beginning of each month in bubble packs.